30th August 2019

Insight from Nikxit Mehta

Time in general practice

2.5 years

Location

Bedfordshire

Qualifications

Masters in Pharmacy (University of Manchester, Independent Prescribing (University of Hertfordshire), Certificate in Diabetes Care (University of Warwick)

Current Role

  • Best thing about being a pharmacist in GP practice: You learn something new every single day.
  • Worst thing about being a pharmacist in GP practice: The work never ends.

My life before becoming a pharmacist in GP Practice

I started off my career through pre-registration and first 5 years in Boots covering various positions in management as well as setting up weight loss clinics. I became a pre-reg tutor, a role I found it very satisfying.

I started locuming for a number of years covering various different multiples as well as independent pharmacies. The aim was to buy my own pharmacy and after a few years of trying I realised I preferred a more clinical role yet found community pharmacy extremely rewarding and learnt a lot about business management.

I managed to get some funding and did the Independent Prescribing course which allowed me to trial in a GP setting for 3 months. This was a huge success and the rest as we say is history.

GP Practice experience

In the last 3 years my role has evolved dramatically and fortunately will be evolving further.

I started off supporting the practice with managing medications requests, telephone consultations, medicines reconciliation, audits, drug alerts, DMARDS management and supporting the incentive schemes. I have now recruited a pharmacy technician and trained her in most of the above so that I can focus on running more clinics.

I currently run clinics in Diabetes, Asthma, CHD, medication reviews and most recently poly-reviews to support our elderly patients by combining all long term conditions under 1 appointment. This has become a great success for both patients as well as GP partners. My aim in the second half 2019 is to start complex poly-pharmacy reviews with the intention of optimising medications as well as de-prescribing especially in the elderly and frail patients. My role will be expanding in training, mentoring and supporting 2 pharmacists who are joining our practices from August 19.

I also support the practice in training, strategic planning and business development. I have a dedicated slot with the practice partners quarterly where I bring business opportunities to the practice to generate more revenues as well as streamlining the business.

I believe pharmacists have a lot of management and leadership qualities to support practices and hopefully practice partnership will become a career pathway.

Key examples of personal challenges of practice pharmacy – what were they and how did you overcome them? (including skills, knowledge and training)

Challenge #1

Managing work load: 

Within six months of joining the practice, I was doing over 50 telephone consultations per day as well as all the repeat authorisations of medications and supporting the practice in Incentive schemes, audits, safety alerts etc. I wanted more clinic time but could not do it until I managed to delegate this work to somebody else.

Solution

I had a few meetings with the partners to convince them to employ a pharmacy technician who would be able to support me and also allow me to be able to have more patients facing clinic time.

After 6 months of intensive training, she has taken over a lot of my administrative tasks and I now manage 50% of my time seeing patients.

Challenge #2

Convincing GP’s for patient facing clinics: 

It took a lot of effort convincing GP partners to allow me to have a patient facing clinic. This was a first experience for them so needed to earn their trust as well as minimising risk to patients. Also we had nurses doing the diabetic reviews so I really had to justify my role.

 

Solution

Certificate in diabetes care: 

I decided to do a certificate course in diabetes and convinced the GP’s I could take over their part as well as combine the nurse’s part in my clinic. I presented my audit results to the practice and also did an ‘evidence based training’ for the diabetes nurses and GPs which convinced them to allow me to run diabetic clinics. I see almost all of the uncontrolled diabetic patients in both our practises including initiating GLP1 and titrating insulins.

Key Messages
  • Managing work within your competence as well as work load is vital. If you want to develop then be innovative in creating a role without overstepping in other roles.
  • Communication to the team is paramount. This will include GP’s to develop role as well as minimising risk, practice manager for the clinics and reception team to ensure the clinics are always booked up.

What are your current priorities / key areas of focus?

  • Upskill in pain management and to improve clinical knowledge to be able to do complex medication reviews.
  • Prepare for the inductions of new pharmacists joining our practice in August.
  • Planning and implementing PCN role which will include recruiting pharmacists as well as forging links with community pharmacy to develop services.

How have you demonstrated impact and value in your practice?

In 2.5 years at the practice I have got complete trust in the partners to allow me the freedom to develop my role, bring in ideas to support the practice be it in training the team or bringing in a pharmacy technician to ease my workload. I have created algorithms to support the reception team to efficiently book telephone consultations as well as changed our repeat prescribing policy with simplified processes.

Although my journey is not from the pilot pathway, I have continued to contribute to the practice be it from saving huge amount of GP time as well as streamlining processes and generating new areas of revenues.

What development do I need / am I undertaking at this point in my journey?

I am currently working on improving my knowledge on Pain Management as well as interpreting pathology results.

My long term aim is to continue improving physical assessment skills.

What skills or competencies do you feel are important to have in your role as a practice pharmacist?

Being able to work as part of a team is essential in a multidisciplinary team. A strong work ethic as well as excellent organisations skills is vital in a busy practice.  A strong desire to learn and develop will aid in role development.

Good consultation skills are important for effective time management of consultations as well as improving patient care.

What has been your perception of the i2i Network?

The training provided by i2i is extremely geared to support practice pharmacist’s role. Their ABCDE method to setting up clinics is vital for pharmacists. The training day was fantastically planned with good clinical knowledge as well as practical tips in setting up clinics and for further learning. They are continually generating new clinics for practice pharmacists to develop new skills.

I wish someone had told me………

The opportunities in GP practice are limitless. This can be from various patient facing clinics be it in LTC, minor ailments or the ACP pathway. Also audits, safer prescribing and most importantly de-prescribing is a niche area in GP practice. Management and leadership qualities can also be utilised in supporting practices in to bring fresh ideas as well as improving processes in the practice. Training and developing fellow team members can also be very rewarding.

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